No abstract

With the unprecedented growth of technology for disease prevention and management, little is known about the experience and adoption of such technology in African American older adults with hypertension. A 90-minute focus group session was used to explore African American older adults' (N = 21) experiences with using technology (mobile devices and applications) for hypertension self-management. Twenty participants reported owning smartphones and used this technology to communicate; seek, acquire, and share information; engage in entertainment; and organize and manage time. Participants expressed concerns about not being informed or trained sufficiently to integrate technology for hypertension self-management. There is a need to develop novel hypertension self-management interventions that integrate technology and training programs for this marginalized population that may help improve blood pressure control and address important clinical and public health priorities of uncontrolled hypertension. [Res Gerontol Nurs. 2018; 11(5):249-256.].

The hormone cortisol is typically assessed in saliva, serum, or urine samples. More recently, cortisol has been successfully extracted from hair, including humans. The advantage of hair cortisol concentration is that it reflects a retrospective representation of hypothalamic-pituitary-adrenal (HPA) axis function over time, much like hemoglobin A1C represents glycemic control. However, obtaining hair samples can be challenging, due to the cultural beliefs and hair care practices of minority participants. For example, African Americans may be reluctant to provide samples. Additionally, few researchers are trained to collect hair samples from African Americans. The purpose of this paper is to present a culturally informed protocol to help researchers obtain hair samples from African Americans. To illustrate the representative results of this protocol implementation, de-identified data from African Americans that participated in a community-based study on chronic stress are provided. Hair practice preferences are assessed. The participants are made comfortable by showing pictures of hair samples prior to cutting their hair. The single strain twist and gently pull method is used to collect approximately 30 - 50 strands of hair from the posterior vertex region of the scalp. This protocol will significantly improve collection of hair samples from African Americans.

Hypertension is a lifelong disease that requires self-management. Additionally, there are disparities in hypertension self-management that disproportionately affect African Americans. Interventions designed in collaboration with older adults have the potential to improve hypertension self-management. The purpose of this design paper is to describe the process in which African American older adults and nurse researchers cocreated an intervention to address stress in the self-management of hypertension. A semistructured interview guide was used to elicit feedback on self-management behaviors to cocreate an intervention with the participants. Participants provided constant iterative feedback on the design used for the intervention. Participants prioritized the content and mode of delivery. African American older adults with hypertension (N = 31; 87% women) participated in two focus group sessions. The primary stressors identified by the group that influenced their blood pressure self-management were as follows: (a) measuring blood pressure and using home blood pressure monitors; (b) difficulty communicating with family and friends; (c) sleep management and pain at night; and (d) healthy eating. Based on the participants' feedback, we created four biweekly (2-hour) group sessions that incorporated their suggestions and addressed their concerns. Health care providers can use this technique to engage African American older adults in participant-centered hypertension self-management.

African Americans are disproportionately impacted by hypertension, suffering earlier onset and greater severity of the disease, and premature cardiovascular mortality, than the general population. Managing hypertension is an unending concern for African American older adults. A better understanding of the self-management preferences of this vulnerable population will lead to the enhanced design of culturally acceptable interventions. This descriptive study examined focus group participants' perspectives on engaging in hypertension self-management activities with the goal of developing a co-created intervention. This study was part of a mixed methods study for which audio- and graphically-recorded focus groups were conducted with community-dwelling African American older adults ( N = 31) diagnosed with hypertension. The majority of the participants were women (87%); the mean age was 72 years ( SD = 7.53). Themes derived from data analyses centered on primary stressors of communication, healthy eating, and sleep related to blood pressure self-management. Based on these, the researchers co-created educational interventions.

The adoption and maintenance of healthy living behaviors by individuals and families is a major challenge. We describe a new model of health behavior change, SystemCHANGE™ (SC), which focuses on the redesign of family daily routines using system improvement methods. In the SC intervention families are taught a set of skills to engage in a series of small, family self-designed experiments to test ideas to change their daily routines. The family system-oriented changes brought about by these experiments build healthy living behaviors into family daily routines so that these new behaviors happen as a matter of course, despite wavering motivation, willpower or personal effort on the part of individuals. Case stories of the use of SC to improve family healthy living behaviors are provided. Results of several pilot tests of SC indicate its potential effectiveness to change health living behaviors across numerous populations.

Self-management of hypertension requires patients to find, understand, and use information to lower their blood pressure. Little is known about information use among African American women with hypertension, therefore the purpose of this study was to examine predictors of self-reported information use to self-manage blood pressure. Ninety-four Midwestern African American women (mean age = 59) completed questionnaires about information behaviors (seeking, sharing, use) and personal beliefs (attitude, social norms) related to self-management of blood pressure. Linear regression was used to identify significant predictors of information use. The total variance explained by the model was 36%, F(7, 79) = 6.29, p < .001. Information sharing was the only significant predictor (beta = .46, p < .001). These results provide evidence that information sharing is a potential health behavior to support intervention strategies for African American women with hypertension.

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